Home / General / The Obama Administration Has Numerous Failures. The ACA Isn’t One of Them.

The Obama Administration Has Numerous Failures. The ACA Isn’t One of Them.

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I agree with some of Sawicky’s critique of Krugman’s Rolling Stone defense of the Obama administration. The point about the kiss up/kick down nature of the criminal prosecutions, in particular, is unanswerable. I don’t agree with the Cornel West argument that he pretended to be something he wasn’t — he strikes me as exactly the moderate liberal Democrat he’s always posed as — but I don’t think anything meaningful or interesting turns on the distinction. The record is what it is, and I think despite some oversimplifications Krugman’s bottom line is correct (only two presidents of the last century could even plausibly claim to have a more substantial record of progressive achievement, which is a successful presidency where I live.)

I can’t say, however, that Max’s attempt at a non-Green Lantern critique of the ACA succeeds:

On the big fucking deal of health care, PK tries to get the best of both sides of the argument. He acknowledges the left criticism of relying on health inscos to fill the coverage gap, then implies that the stupid left doesn’t understand a single-payer plan would not have gotten enough votes to pass. What the not-actually-stupid left really wanted and had a right to expect was the inclusion of some kind of public option, which was arguably not a manifestly disabling feature from a political standpoint. And even if it proved to be so, there is no reason to make a rhetorical virtue in the form of bogus celebrations of “the market” out of a political necessity.

First of all, sad as it is the single-payer argument isn’t a strawman. There are otherwise very smart liberals, not just on the intarwebs somewhere but in the New York Review of Books, that we could have had single payer had Obama only Bully Pulpited the Overton Window Under the Bus on Steroids. (There’s a variant of the argument that concedes that single payer probably wasn’t viable, but Obama should have made it his opening bid, on the theory that if you walk into an Audi dealership and offer $500 for their best car they have no choice but to sell it to you for $1,000.)

But I agree that the more common critique was the failure to include a public option. On that, two points. First of all, a public option was worth trying, but I don’t agree that it was a magic bullet that would have transformed the ACA from hopeless neoliberalism to real progressivism. The public option passed by the House would have had, at best, a minor impact on the exchanges. It was not the road to nationalizing the health care industry. But the policy merits are moot, because it’s pretty obvious that the votes even for the weak House version weren’t there in the Senate. I don’t know how anyone could see how Lieberman acted and still think that it could have gotten 60 votes. Max doesn’t even try to outline what leverage Obama had over the many Senate Democratic opponents of a public option, which given how such conterfactuals tend to go is probably for the best.

The fact that Max doesn’t. even. try. to explain how a public option could have passed suggests that this isn’t his biggest issue with the ACA. The more important one seems to be his objection to Obama “mak[ing] a rhetorical virtue” out of the exchanges. (He’s been even more explicit about this before, conceding that Obama got about as much as could have been expected out of Congress but criticizing him for various alleged Bully Pulpit failures.) The theme continues here:

This problem of turning a practical limitation into a rhetorical virtue afflicted the inadequate stimulus plan as well. Instead of taking what could be gotten but acknowledging the level was insufficient, the Administration acted as if it was all good. It wasn’t. PK again agrees. He can say it but you can’t.

Well, anyone can say it; the question is whether the inadequacy is plausibly Obama’s fault, and Max doesn’t really argue that it is. But leaving aside that I don’t think that presidential rhetoric matters very much, I don’t understand this particular criticism even on its own terms. Obama is supposed to run down the important legislation he signed? I’m not really inclined to urge that presidents demonstrate political incompetence.

On a final point, on the ACA I continue to reject the idea that it reflects “neoliberalism.” As always, missing from these arguments is the Medicaid expansion. As far as I can tell, none of Obama’s critics from the left would disparage the original Medicaid that covered a fraction of a fraction of the poor as “neoliberalism,” and yet a Medicaid that covers everyone within 138% of the federal poverty line is not seen by Obama’s left critics as an accomplishment worthy of any particular note. The focus is on the exchanges, suggesting that had Obama (like Great Society Democrats) just done nothing for the uninsured who don’t qualify for Medicare or Medicaid he would somehow be more progressive than he was because he used more regulated and subsidized markets to insure people. This doesn’t make any sense. If the U.S already had single payer or national health, you could call it “neoliberal” reform. If single payer could plausibly have passed, you could call it “neoliberal.” But given the actually existing status quo ante, it’s not “neoliberal” in any sense. When Obama touts it a a major progressive achievement, he’s not just doing what any politician would, he’s right on the merits.

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  • howard

    anyone who didn’t recognize obama as the moderate that he is made his or her own mistake: they weren’t misled by obama except to the degree that they wanted to be (and yes, cornel west, i’m looking at you).

    as for the aca, i’m a fan of sawicky, but honest to god, if you can’t get behind the tremendous improvement that the aca is over the pre-existing status quo, then maybe you’re not as much of a progressive as you think you are.

    • Craigo

      A subset of people on the left base their dissatisfaction to both the pre and post-ACA status quo primarily on hostility to for-profit corporations, not any real concern for the uninsured or underinsured.

      So in that respect, the ACA was not a genuine improvement. But I agree that such a perspective is neither liberal nor progressive.

      • Sly

        So in that respect, the ACA was not a genuine improvement. But I agree that such a perspective is neither liberal nor progressive.

        It’s liberal/progressive, just an absurdly stupid form of liberalism/progressivism.

        • Davis X. Machina

          …especially when it shades off into ‘the worse, the better’ism

        • witlesschum

          It’s not absurdly stupid in a country and a world that has big problems caused by the power of for-profit corporations to feel somewhat hostile toward them. Or more accurately, argue that they need to be much, much more stringently regulated in almost every respect.

          It’s just not any reason to throw the ACA out with the bathwater, even rhetorically. As far as my personal leftist position anyway, the ACA is good start and an improvement on anything anyone before Obama did. So good for him. Just because it’s not even the best thing doesn’t mean it’s not a good thing.

          • Sly

            It is stupid to believe that (a) the power of for-profit corporations is evenly disbursed among those corporations, (b) that for-profit corporations are ideologically monolithic and (c) that the power of for-profit corporations can best be challenged by a single political agent operating in a decentralized system of governance but who can overcome that by just having the the courage to lead with leadership.

            • witlesschum

              It’s probably good that no one believes that, then.

        • Specifically, it’s a kind of liberal/progressivism that is more anti-corporate than it is pro-anything. Which, given that poor/working class people and people of color usually need the expansion of services more than they’re willing to be fussy about how, usually means a very middle-class/affluent white progressivism.

          I’d be willing to bet that there’s a strong overlap between these folks and people who emphasize lifestyle consumerist politics.

    • DrDick

      Exactly. He is pretty much exactly what I thought he was when I voted for him. I never understood all that clamor about “a transformational figure.”

      • jim, some guy in iowa

        seems like they all say they want to be “transformational”- why people took O so seriously is an interesting question- but they did. locally a lot of non-political people busted ass for him in a way they never did before and probably never will again

        • Jordan

          I don’t think its a particularly hard question.

          Before Obama there were 8 years of Bush and 6 years of Clinton before you had a previous presidential candidate that liberals/progressives could have possibly identified with as a transformative figure. That covers *a lot* of time.

          Add to that Obama being the first black president, and the real, true shitstorm that was Bush’s presidency … yeah, like I said, not that hard to see how many, many people would have taken it to be “transformational”, whatever that means.

          • jim, some guy in iowa

            the people i am talking about were not very likely to identify as “liberal/progressive”- or even “political”

          • LiveFreeOrShop

            Good points from Jordan and some guy. I was also inspired by having our first Af-Am president, but I’m hugely suspicious of ANYONE connected to the University of Chicago. Way too much destructive stuff–from Leo Strauss to Milton Friedman–has come out of there. Likewise what seemed to be his closeness to the banks.

            • DrDick

              He was also a product of the Chicago Machine, which is not notably progressive.

            • FlipYrWhig

              Saul Alinsky, Kurt Vonnegut, Carl Sagan, and Sy Hersh say hi.

              You may be conflating the U. of Chicago generally with the Chicago school of economics. I’m not an expert but AFAIK Obama has had no association with the latter.

            • tsam

              I’d point to Harvard Law before U of Chicago as a corrupting influence.

            • djw

              I’m hugely suspicious of ANYONE connected to the University of Chicago. Way too much destructive stuff–from Leo Strauss to Milton Friedman–has come out of there.

              This is absurd.

        • Anon21

          I agree that it’s an interesting question as to why he was so inspiring to those people. A partial explanation could be that he’s a good speaker who spent a lot of his time talking about political-cultural transformations he couldn’t deliver. (Non-political types are generally unsophisticated about politics, and do not understand that a President is no position to create bipartisan comity.)

          • jim, some guy in iowa

            yeah. it wasn’t *all* projection on their part. people tend to forget the O hard sell about being able to do things no one else could do- which, when it came to the aca, certainly turned out to be true, so…

            • Jackov

              It was the best political marketing campaign any of us will likely ever witness. The Obama campaign was, in part, an evangelical movement complete with ‘holy’ book, conversion narratives and scripts for gaining more adherents.

              You simple wouldn’t believe how much that book changed peoples’ lives.

              • djw

                It was the best political marketing campaign any of us will likely ever witness.

                Right. These debates are a testimony to what a fantastic campaign it was. So many people across the non-wingnut political spectrum, including people who really should have been a bit more resistant to such things, saw what they wanted to see.

                • joe from Lowell

                  I’ve seen numerous people proclaim that Barack Obama betrayed his campaign promises by sending troops to Afghanistan, using drones against al Qaeda leaders in Pakistan, and attempting to work compromise deals across the aisle.

                  I mean…COME ON, PEOPLE!

                • The Temporary Name

                  There was bogglement for me in having a black guy with Hussein in his name get elected. It was an inevitability once he was nominated – he and his campaign machinery looked good and Bush had poisoned the Republican well – but I can still recall my own WTF moment when the election was called, despite myself. If one fantasy can come true why can’t I have my atomic solar-powered car? A stupid sentiment, as policy changes/law-signings will never evoke that kind of excitement.

        • DrDick

          Except when he actually talked about being “transformational”, he was talking about bipartisanship and compromise (anathema to modern Republicans).

      • Ahuitzotl

        oh he was transformational alright.

        He transformed the Republican from vicious pettyminded plutocrat-worshippers, to stone-cold insane vicious pettyminded plutocrat-worshippers

        • tsam

          Yeah, and all he had to do to get that done was be black. The guy is crushing it.

      • joe from Lowell

        Exactly. He is pretty much exactly what I thought he was when I voted for him.

        I spent the 2008 campaign describing Obama as a cautious moderate liberal. When the libertarians and conservatives called him a socialist, my go-to was “Oh, come on, the guy isn’t even proposing a single-payer health care plan.” I mean, the great leftist hope was proposing a health care plan that was nearly identical to what Hillary Clinton was proposing? I think perhaps this is why the lefties came down so hard on the individual mandate in 2009 – because that difference was the one thin reed they could cling to to explain why they weren’t actually supporting a center-left candidate.

    • tsam

      I think lots of people, regardless of political ideology have a tough time distinguishing between what politicians promise and what people wish they had promised. The hope and change stuff was all political bluster and one needs to be pretty silly to take those two completely unspecific platitudes and turn them into a national health care program.

  • Sly

    The fact that Max doesn’t. even. try. to explain how a public option could have passed suggests that this isn’t his biggest issue with the ACA.

    Is there anyone still seriously arguing that the Public Option would have gotten through the budget reconciliation rules? The Senate Democratic Leadership dropped it liked a hot potato as soon as they started consulting with the parliamentarian on what could and what could not be included in a reconciliation bill. I don’t think anything was ever explicitly said, one way or another, on how the parliamentarian would rule if an objection was made, but the timing would suggest that it would have caused problems for the entire bill.

    Of course, I’m speaking from the position of someone who actually cares about the effects of policy on real people, and not as someone who cares about policy as a shibboleth.

    • DrDick

      Right. I strongly supported single payer/public option, but it was pretty clear that the votes were no there.

    • Scott Lemieux

      Right. The problem with reconciliation is that you’d not only still have all the conservative Dems but have trouble with the procedure wankers like Leahy and Finegold.

  • c u n d gulag

    I knew going in, that Obama was a slightly left-of-center Democrat.

    To think otherwise, was to project your hopes and aspirations, onto him.

    He has been a terrific President who, while he had a Democratic Congress, got a ton of good things accomplished!

    And for that, I respect, and thank him!

    • Steve LaBonne

      Exactly. The history books will be a lot kinder to him than the more progressive than thou crowd has been.

      • Malaclypse

        The history books will be a lot kinder to him

        Not if the Texas Board of Edumaction has anything to say about it.

        • DrDick

          If Texas has anything to say about it, he will not even be in the textbooks.

    • altofront

      To think otherwise, was to project your hopes and aspirations, onto him.

      I did that, so I have enormous patience for other people who did the same. (And, honestly, I get a little tired of condescending remarks from those who never got swept up in the campaign. Mea culpa–it was possible to dream, for once.)

      I have no more patience for people who ignore how legislation actually happens and make the president into a kind of fetish object.

      • witlesschum

        I have no more patience for people who ignore how legislation actually happens and make the president into a kind of fetish object.

        This. It’s like the taproot of every species of wankers. From the Obama is no different than Bush crowd to so-called pundits of the politico stripe to uneducated centrist morons who only vote in presidential years, they all think the presidency is a magic pony farm because the real world is too complex for their precious little brains.

  • FlipYrWhig

    there is no reason to make a rhetorical virtue in the form of bogus celebrations of “the market” out of a political necessity.

    What is this specifically referring to? And is there any way to distinguish a “bogus celebration of ‘the market'” from standard-issue market = choice = freedom Americana rhetoric that dates back 60-plus years at least?

  • Dr. Ronnie James, DO

    Meanwhile, on Planet Reality (where all the actual poor people live), free clinics are closing because so many of their clientele can now find…
    …affordable…
    …care.

    Huh.

  • JustRuss

    Regarding the Single Payer Purity Trolls, I recall being at a townhall with my congressman in 07 or 08 when the topic of single-payer came up. He dismissed it as being “too disruptive”. He’s a founding member of the Progressive Caucus. If even those guys aren’t on board, it ain’t gonna happen. I do wish they’d pushed harder for a public option, but, well, Lieberman et al.

    • Pat

      Individual states can and have set up variations on the public option. If it works well, you can bet that most of the blue states will have a variation on it in the next 15 years.

      While that does nothing for the red states, they are always free to vote the bums out if they need to save their local health care system…

      • Dr. Ronnie James, DO

        AMEN. The existence of this is like the litmus test for Single Payer Purity Trolls. If they don’t know this, they don’t actually care about health care & are straight trolling.

  • BrianM

    This bit of Sawicky’s rings true to me, though:

    This problem of turning a practical limitation into a rhetorical virtue afflicted the inadequate stimulus plan as well. Instead of taking what could be gotten but acknowledging the level was insufficient, the Administration acted as if it was all good. It wasn’t. PK again agrees. He can say it but you can’t.

    I remember at the time wishing Obama would tone down his praise of the stimulus. I was inclined to believe the people who thought it was too small, so I figured Obama was going to get tied to a sputtering economy without having a “I warned you – put the blame where it belongs” comeback.

    Is that Bully Pulpitism? Is announcing you’ll reluctantly give in as futile a gesture as coming out strongly in favor of something? (In which case, I guess the President – in his public face – is nothing more than the kind of head of state who announces his pleasure whilst signing H.Res. 495: Encouraging people in the United States to recognize March 3, 2014, as Read Across America Day.)

    • jim, some guy in iowa

      yeah… it’s a tricky thing, though. you don’t want to antagonize people who carried water for you or people who gave you some of what you wanted (even if neither did as much as you wanted/expected/needed), and the u s government is chock-full of egomaniacs who have easily hurt feelings- same as everywhere else i imagine

    • FlipYrWhig

      I don’t think pouting that the stimulus was OK, kinda, but it still shoulda been a trillion dollars would have been a PR bonanza.

      • Pat

        I don’t think that there was any consensus at the time that it HAD to be that high. It’s such a stupid meme, Brian. We were in a time of crisis and flux, and people just didn’t know. They made a guess, which was a little low, but they acted to stabilize the economy.

        Why can’t you complain that Republicans won’t let us invest in infrastructure instead? Or research? Public works is a proven stimulus, and in recessionary times an excellent value. At least then your complaints could push people towards a positive action.

        • FlipYrWhig

          It was also fairly easy to tell that the idea of crossing the “trillion” threshold would give a lot of people, including many Democratic office-holders, the heebie-jeebies. That was always going to be the upper bound, logic be damned.

          • joe from Lowell

            And in fact, despite the ARRA being under $800 billion, what was the term the Republicans all used to make it sound scary during the debate?

            “Trillion-dollar stimulus plan”

            The phrase “trillion-dollar” was adopted by the bill’s opponents as a scare-word.

        • Jackov

          Romer’s work showed that $1.8 T was likely necessary to cover the total output gap.

          When Romer showed Summers her $1.7-to-$1.8 trillion figure late the week before the memo was due, he dismissed it as impractical. So Romer spent the next day or two coming up with a reasonable compromise: $1.2 trillion. In a revised document that she sent Summers over the weekend, she included the $1.2 trillion figure, along with two more limited options: about $600 billion and about $850 billion. At first, Summers gave her every indication that all three figures would appear in the memo he was sending the president-elect. But with less than twenty-four hours before the memo needed to be in Obama’s hands, Summers informed her that he was inclined to strike the $1.2 trillion figure. Though Summers, like Romer, believed more stimulus was almost unambiguously better, he also felt that a $1.2 trillion proposal, to say nothing of $1.8 trillion, would be dead on arrival in Congress. Moreover, since Obama’s political operatives were convinced that any stimulus approaching a trillion dollars was hopeless, Summers worried that urging more than this amount would stamp him and Romer as oblivious in their eyes. “$1.2 trillion is nonplanetary,” he told Romer, invoking a Summers-ism for “ludicrous.” “People will think we don’t get it.

          The memo also includes a comprehensive round-up of the counsel offered by outside economists on the side of the stimulus. It notes that Paul Krugman was calling for $600 billion in the first year, Robert Reich wanted $1.2 trillion over two years, Jamie Galbraith wanted $900 billion in the first year, Ken Rogoff wanted $1 trillion over two years, Mark Zandi wanted $600 billion, Lawrence Lindsay wanted at least $800 billion, and Greg Mankiw — who is now a top Romney adviser — was “the only economist who we consulted with who refused to name a number and was generally skeptical about stimulus.”

          There’s an interesting backstory to that portion of the memo: When Rahm Emanuel was informed that the economic team wanted to push an $800 billion stimulus, which was larger than anything anyone else in the political system was proposing, he demanded that they get a lot of outside economists on the record with very large estimates. And so the team began doing just that.

        • BrianM

          Why can’t you complain that Republicans won’t let us invest in infrastructure instead?

          While I admit below that I’ve been talked out of my position, a side note on the above. I have complained about it. The answer has consistently been “we already tried that with the stimulus, and it didn’t work” with a big helping of “they couldn’t find shovel-ready projects [because of those damn environmentalists”].

          As others have argued, the first shot was going to be the only one.

    • djw

      I figured Obama was going to get tied to a sputtering economy without having a “I warned you – put the blame where it belongs” comeback.

      No, that’s putting way too much faith in a message/argument. There’s no good reason to believe presidents can talk their way out of blame for the economy; whether the arguments they put forth are good ones on the merits is largely immaterial.

      • Anon21

        Exactly. And to the extent message/argument matters, “My overwhelming Congressional majorities gave me too little of what I asked for” is a horrible argument to have to take to the public. It’s going to reek of excuse-making and covering your ass. Not to mention that it will piss off the marginal reps who stuck their necks out to pass the law in the face of near-united GOP opposition.

        • ericblair

          It’s going to reek of excuse-making and covering your ass.

          Right, this is exactly it. It fits with the more-progressive-than-thou crowd because deliberately or not they will piss over anything that actually ends up passing, because if they don’t they may be held responsible for the outcome and We Can’t Have That. If you’re not committed to a rosy utopian counterfactual than you’re not pure enough.

          Presidents are going to own the economy, and any attempt to weasel out of it is going to look like exactly what it is. And then the people who were beating him up that he “just didn’t try” are going to beat him up that he “didn’t try hard enough and really is a crypto-fascist who wanted to fail.”

          • FlipYrWhig

            The thought process is that anyone who’s satisfied is a patsy. It’s always right to be disappointed, because that way you’re nobody’s fool. And of course “didn’t even try!” becomes “tried wrong”/”blew it” instantly.

            • Davis X. Machina

              The Church of Savvy is bi-partisan.

          • synykyl

            More-progressive-than-thou. Special Snow Flake. Green Lanternism. Reality Based Community.

            Am I the only one who is tired of these stupid catch phrases?

            I’m not saying that people who use these terms don’t make some good arguments, but come on. Let’s leave that crap to assholes like Rush Limbaugh ;-)

            • Moondog

              You forgot Pony.

            • liberalrob

              They’re a convenient way of 1) dismissing the arguments of people you disagree with while simultaneously 2) not engaging those arguments (perhaps legitimately, if it’s a recurring topic) and 3) snidely putting them down by associating them with those cliche’ labels. Kind of a hat-trick for the aspiring comment-section snob. Saves electrons!

              • 1) several of them are reasonable names for phenomena; if you think they don’t apply, then show it

                2) oh please; at least here, there’s a metric ton of engagement in even the silliest, nakedly bad faith arguments not to mention a lot of cry babying about snark.

      • Agreed. Although I think that “I warned you” is the wrong idea.

        I think the message is: stimulus is working, economic growth is improving, spending is increasing, job losses are shrinking and will turn into job gains, time to finish the job.

        Not that would prevent 2010, but a bunch of jobs bills might have limited the damage a bit.

    • Scott Lemieux

      So Krugman and Sawicky agree that the stimulus was too small, and agree that it probably couldn’t have been substantially bigger given Congress, but disagree over whether Obama should have given speeches attacking ARRA. I think Krugman is right for the reasons several have discussed above, but more than that I think who gives a shit? Can anyone seriously think a second round of stimulus would have passed if only Obama said the first one sucked?

    • BrianM

      I’m pretty much convinced that there’s no point in bruising the egos of those who supported legislation in order to get protection from criticism. Specifically because the protection won’t work very well.

      That is: I was wrong.

      Thanks.

  • Denverite

    As always, missing from these arguments is the Medicaid expansion. As far as I can tell, none of Obama’s critics from the left would disparage the original Medicaid that covered a fraction of a fraction of the poor as “neoliberalism,” and yet a Medicaid that covers everyone within 138% of the federal poverty line is not seen by Obama’s left critics as an accomplishment worthy of any particular note. The focus is on the exchanges, suggesting that had Obama (like Great Society Democrats) just done nothing for the uninsured who don’t qualify for Medicare or Medicaid he would somehow be more progressive than he was because he used more regulated and subsidized markets to insure people.

    Based on the estimates I’ve seen, between two and three times as many formerly uninsureds enrolled in Medicaid vs. purchased insurance on the exchanges.

    • Pat

      From Charles Gaba at ACASignups.net:

      7.4 million on the exchange (8 million paid); 8 million off exchange; 11-12 million Medicaid/Chip/other.

      • Denverite

        Hmm. So a little less than two times.

        • Pat

          Where did you get your information?

          • Denverite

            It’s been long enough that I don’t remember. KFF maybe?

      • Scott Lemieux

        And, of course, if not for the Supreme Court re-writing the law the numbers would be much higher.

  • Jordan

    The public option passed by the House would have had, at best, a minor impact on the exchanges.

    Could you expand on that?

    • altofront

      Here are two points to remember about the Public Option that actually passed the House:

      1) It would only have been open to individuals buying coverage and businesses employing fewer than 100 people. (Larger employers might be allowed to participate later, on a case-by-case basis.)

      2) Rates would be negotiated with providers, not set at Medicare levels.

      As a result, the CBO estimated that rate would be somewhat higher than comparable private plans, that the public option would mostly be used by less healthy people, and that only about six million people would eventually enroll in it.

      So, a nice thing to have, sure, but not really a transformative policy achievement.

      So leave aside the fact that no version of the public option was likely to pass the Senate, and think about the 2008 House: 257 Democrats to 178 Republicans; over 80 members (and half the committee chairs) in the Progressive Caucus; the strong leadership of Pelosi; and a burning desire among Democrats to produce landmark healthcare legislation. Without a doubt, the most liberal House we’ve had in generations. And this is the best they could pass.

      • Jordan

        Fair enough. I guess I was thinking it could play a much bigger role by establishing the infrastructure for future improvements. But Lemieux was clearly making a more targeted point, which seems right to me now. Thanks!

    • Moondog

      Apparently, the public option

      (a) wouldn’t have mattered to progressive goals

      yet for some reason

      (b) was strongly opposed by the insurance industry and their bought politicians.

      I don’t get it.

      • djw

        Why not? Why do you find it implausible that something might have made only a minor contribution to progressive goals, while taking some business away from the insurance industry?

        As discussed elsewhere in this thread, while it’s true that progressive goals are often at loggerheads with insurance industry profits, it’s obviously not the case there’s a 1-to-1 ratio here.

        • Moondog

          Well, for one thing, one of the main points of having a public option was to create an alternative to requiring people by law to hand money to private companies. 1:1.

          It was absolutely critical to making the ACA not, yes, neoliberal.

          Which is of course why that failed. Not arguing that one could have passed, just that saying it was unimportant (based on the House version, I guess — which was nobody’s idea of “robust”, the word which was the goal, right up til that point) — it strikes me as bizarre.

          • altofront

            The House version was fairly unimportant; a version that used Medicare rates and was open to everyone would have been a big fucking deal. It might even have killed off private insurance. But nobody could pass something like that.

            By the way, the public option also would have required people “to hand money to private companies.” They’re called hospitals. For all the legitimate complaints people have about insurance companies, most of the money problems of the current system stem from how much money hospitals and doctors charge. So unless you have a plan to nationalize healthcare providers you’re not going to escape “neoliberalism” (aka capitalism?).

            • Moondog

              I’m not the one saying the House version was important. In TFA above, the House version is used to explain that the very idea of a public option was “not a magic bullet.” I’m trying to point out the flaw in that reasoning.

              There’s a huge difference between paying premiums to private for-profit insurance companies and paying for a government underwritten plan.

              Neoliberalism is not capitalism. It’s the government’s relationship to capitalism.

              • altofront

                I don’t see the flaw. Scott clearly doesn’t mean “any imaginable public option”; he means “a public option that we can imagine becoming law.”

                There’s a huge difference between paying premiums to private for-profit insurance companies and paying for a government underwritten plan.

                What is it?

                Neoliberalism is not capitalism. It’s the government’s relationship to capitalism.

                If neoliberalism means anything concrete these days (and I’m dubious), it’s connected to a belief that the market is inherently better at delivering services than the government is and a drive towards deregulation on principle. The ACA is pointed in the opposite direction on both of these.

                • Moondog

                  The big differences that come to mind: The one is for profit and apparently infested with sociopaths in its top ranks. The other would be accountable to us.
                  Your point is well taken re neoliberalism and the ACA.
                  This huge new government subsidy of private industry, that’s what I was focused on. My own fairly foggy definition includes the furthering of unfettered movement of capital, destruction of the safety net, privatization of public goods…ye auld “neoliberalismo”
                  In any case I’m sure it’s true, the ACA is only neoliberal if you compare it to the ideal alternatives.

          • Well, for one thing, one of the main points of having a public option was to create an alternative to requiring people by law to hand money to private companies.

            Say what?

            How is this of interest much less of value. From a health care perspective, it doesn’t matter per se at all (we wouldn’t be happy with a German style system…really?)

            It was absolutely critical to making the ACA not, yes, neoliberal pass.

            FTFY!

            Seriously though, you need an argument that being nominally not neoliberal is interesting. PO as a gateway to single player or German style system…great! PO which ends up subsidising insurance companies by getting all the sicker people…not so great.

          • But Medicaid expansion is an alternative…for people at 138% or less.

            Or are we saying it only counts if middle class people are the ones escaping the market?

            • Moondog

              Are you saying middle class people don’t count?

              No, of course you are not.

      • Sly

        (a) wouldn’t have mattered to progressive goals

        I wouldn’t say it “didn’t matter,” but that it wasn’t as important as the insurance regulations included in the ACA, the subsidies, and the Medicaid expansion. If including the PO threatened those things – and I argue that it would have – then its not worth it. It’s not a question of “Everything in the ACA as written” vs “Everything in the ACA as written plus a public option,” it’s a question of “Everything in the ACA as written” vs “Nothing.”

        (b) was strongly opposed by the insurance industry and their bought politicians.

        Minor quibble: It was the hospital lobby and state insurance commissioners that killed the public option (the latter is also responsible for killing a national insurance exchange), not the health insurance lobby. The insurance lobby was too busy trying to get its shit together to actively ruin anything; the basic framework of the ACA capitalized on the existing war between for-profit and non-profit insurers, essentially giving the non-profits what they wanted but sticking it to the for-profits. That AHIP seemed schizophrenic during reform negotiations was due to it dealing with two different constituencies with divergent interests.

        Vermont basically did the same thing with their own insurance reforms in the 90s. The big for-profits like Anthem threatened to leave the state if the reforms passed, and then-Governor Dean told them not to let the door hit them in the ass on their way out because the non-profits were onboard.

  • Joe_JP

    the kiss up/kick down nature of the criminal prosecutions

    I don’t really know what this means so yes it’s kinda “unanswerable.” Maybe, it refers to this:

    As for Wall Street not being punished, is that not the case? Who has been punished? When it comes to big-time financial and war criminals, the president has said “We need to look forward as opposed to looking backwards.”

    We have been down the road as to the first part already is a recent thread where people noted that “financial” parties have been “punished” via fines and/or compensation. It was not just “look forward.” As to “war criminals,” I get the point, though even “small” fry here weren’t punished, were they? It simply is beyond the realm of reality to think he had a shot at targeting the actual big fry here. Cheney was not going to be put in the dock.

    Anyway, he does note the “incremental” gains as to health care (his phrasing is a bit opaque) and says we should demand more. That’s fine. But, goes off the rails in what “could” have realistically happened, surely as a matter of “Obama” (“Obamacare” notwithstanding, it isn’t all about him — again, that name is bad on some many levels, even if it is not 100% bad).

    Sometimes, left leaning sorts should be better members of the reality based community.

    • mpowell

      This is an interesting point. If you’re not going to prosecute Bush and Cheney, you’re still kicking down, aren’t you? And I don’t think the state would survive a war crimes prosecution of a former president unless his base had abandoned him. There would be a lot of damage to the institutional fabric at least.

  • Gregor Sansa

    In principle, there were three technical paths for a public option to become law:

    1. Pass the senate over a filibuster.
    2. Pass the senate through some form of nuclear option.
    3. Get put in in reconciliation.

    Now, there are real arguments that none of these were likely. But the converse of the sacred principle of “if there are multiple necessary causes then none of them is really a cause, because poker” is that “if there are multiple sufficient paths then at least one of them could have plausibly happened”.

    More seriously: I think that the chances of those were about 5%, 10%, and 15% respectively, so that adds up to almost 30%, which is below 50% but not entirely negligible.

    • I don’t see what gives you any of those confidences. Nuclear option? In 2009? Were there 20 votes? It was esp hard with a near filibuster breaking majority.

      Bacus was against the PO before he was lukewarm about it and Leiberman the reverse. Wasn’t going to happen.

      (Even normal measures spooked democrats. Remember “demon pass” (deem and pass)?)

      • NonyNony

        As far as “nuclear options” go let’s remind ourselves that it took until 2013 to get the Senate majority on board with the idea that maybe if Republicans were going to filibuster every goddamn minor appointment that the President tried to make then maybe it was time to eliminate the filibuster. But only for presidential appointees to non Supreme Court positions.

        If you think the votes were there for a nuclear option in 2009 for legislation you are denying reality as it stood. There wouldn’t even be the votes for the nuclear option for legislation today if Reid were pushing for it (which would be pointless because of the House) let alone in ’09.

        • FlipYrWhig

          There’s no way people like Feingold and Byrd would have gone for a nuclear option of any kind.

      • Davis X. Machina
      • Joe_JP

        Yes. I doubt a public option could pass with a simple majority, push comes to shove.

    • mpowell

      Adding up several small errors gets you big errors. Let’s propose 1%, 1% and 1%. That’s probably a more accurate picture.

      • tsam

        Hopey McChangey could do it with an executive order. He DIDN’T. EVEN. TRY.

    • Scott Lemieux

      The chances of the first two were 0% and the third not much better.

    • djw

      Those numbers are all obviously way too high, but I’d put a higher number for (1) than (2). Senators’ attitudes toward the public option were (at least in part) a reaction to the politics of the moment; their attachment to the filibuster was far deeper and, as fucked up as it is to say this, more principled.

  • LiveFreeOrShop

    As the House and Senate versions went to compromise, Scott Brown won Kennedy’s seat in a special election and the Democrats lost their 60-seat super-majority. Since the Senate had already voted in favor of their version but the House had not passed theirs, it was decided–wisely–to adopt the Senate version since the Senate would not likely pass another.

    I think having a public option would have been significant, but not immediately–three years minimum. The feds would have appropriately waited to see how the exchanges worked out before putting in too much effort. Still too soon to tell, but I think a public option could have been used to push for wider networks, which I think are currently a problem.

    But why focus on a lightweight like Sawicky? The writing is barely tolerable, heavy on immature, uncreative snark and low on insight. Bore me to tears, please. Shirley there are better bloggers, preferably decent economists, who might take issue with Krugman’s article.

    • Pat

      Shirley, get on the horn and find me some better bloggers!

    • Dr. Ronnie James, DO

      Having just started visiting this site in the last year or so, it is sometimes like an ESPN Classic replay of the blog wars of 2002-2004 – names I’d forgotten about since roughly “You forgot Poland” keep popping up: Glenn Reynolds! James Lileks! Roger Simon! Ann Althouse! Thomas Frank! Without this site, I’d have never known they were still active/relevant/alive. Say, what’s Hindrocket been up to the last decade?

  • I’m still convinced the Multi-State Plan jointly run by the federal OPM and Blue Cross in 30 states and DC is going to be the public option when it grows up. Of course it cuts in a nonprofit insurer, so it’s not “single-payer”, but neither are the programs in France and Germany and everywhere else in Europe, which certainly perform at least as well as the true single-payer systems in UK and Canada.

  • CrunchyFrog

    I don’t agree with the Cornel West argument that he pretended to be something he wasn’t — he strikes me as exactly the moderate liberal Democrat he’s always posed as — but I don’t think anything meaningful or interesting turns on the distinction.

    Sure, if we ignore his 180-degree flip-flop on the legality of warrantless spying and, related, on prosecuting whistleblowers. I realize that these issues aren’t front-and-center for most people, but you can’t deny that he has done exactly the opposite of what he said in his Senate speeches on these topics.

    • FlipYrWhig

      I don’t find it terribly surprising that a president has different views on presidential authority than a senator-who-is-not-president does. In his heart, who knows. But I don’t know too many presidents who take up the cause that they have too wide a latitude and that their powers should be restricted. If I were the president, I wouldn’t knock myself out ceding powers to the dithering dumbfucks and cowards in the legislative branch. I’d probably be trying to childproof Congress so they didn’t burn down the house by jamming loose metal into the outlets.

      • Joe_JP

        Yes. And, by the time he ran in 2008, he was being called out for “flip-flopping” that amounted to accepting warrantless spying (a term that is complex anyway) legislation as the best possible, even if in “speeches” he would do more.

        For good or ill, that is what moderate lib Dems do on the national level these days.

    • NobodySpecial

      I realize that these issues aren’t front-and-center for most people, but you can’t deny that he has done exactly the opposite of what he said in his Senate speeches on these topics.

      Or what he did as an Illinois state senator, for that matter.

    • joe from Lowell

      Obama hasn’t changed his position on warrantless spying.

      His administration has gone through the FISA courts for everything.

  • jroth95

    on the theory that if you walk into an Audi dealership and offer $500 for their best car they have no choice but to sell it to you for $1,000.

    This, of course, is in contrast to Scott’s clearly correct contention that, if you walk into an Audi dealership and offer to pay sticker price, the dealer will try to talk you down to the normal $5-10k discount that everyone else would pay.

    In every legislative proposal, Obama’s ask is exactly what he’s hoping to get, apparently on the premise that most negotiations end where they start. Scott, of course, treats any criticism of this approach with content-free snark like that quoted above. He never explains in what world Obama’s approach is any more rational.

    • This, of course, is in contrast to Scott’s clearly correct contention that, if you walk into an Audi dealership and offer to pay sticker price, the dealer will try to talk you down to the normal $5-10k discount that everyone else would pay.

      Er..no.

      In every legislative proposal, Obama’s ask is exactly what he’s hoping to get, apparently on the premise that most negotiations end where they start. Scott, of course, treats any criticism of this approach with content-free snark like that quoted above. He never explains in what world Obama’s approach is any more rational.

      Except this is blatantly false. You act as if the public proposal is the start of the negotiation or that any one deal was independent of the rest and that the negotiating partners didn’t have a ton or leverage and weren’t likely to be very pissy.

      Or even that there weren’t multiple parties each of which had to be placated.

      Furthermore, in hindsight, various Democratic players overvalued having Republican votes (including Obama). Part of the problem is that the game changed around the time of the ACA when the rigid opposition party approach consolidated. In prior times, with the margin they had in the senate, the Dems could have hoped to pick up moderatish Republicans quite regularly. Whether this would have provided significant cover is doubtful, but it was a well established and not entirely bonkers model.

      Note how Obama changed his strategy during the debt ceiling fracases. There he made “reasonable” offers then upped them in order to provoke the house into silliness (and commenters into treating them as silly).

      Negotiation is different when you don’t particularly want something than when you need it. It’s also different if you have multiple negotiations in view.

      • Another fun incident: The meet with house republicans wherein he made them look like fools by you know letting then be their awful selves while he was his normal smart self.

        Note that the repubs never ever did that again (although they still complained that he wouldn’t meet with them).

        While a delicious moment, it arguably was a minor (very minor) misstep.

        The other thing to keep in mind is that Obama was and is facing a continual series of delegitimization attacks. Every Dem prez gets them, but Clinton and Obama face the fundamental belief of republicans that only a republican is allowed to be president. This is as fundamental as always cut taxes on the rich and widely regarded as reasonable by the establishment.

      • joe from Lowell

        Yes, this.

        The auto-dealer negotiation analogy has a big flaw: the outcome of your negotiation with the auto dealer doesn’t depend on how the public and various other observers judge the two sides to be doing during the negotiations. Neither the auto dealer nor the customer are going to adjust their offers and responses based on feedback from people observing the negotiations – unlike political negotiations.

    • Scott Lemieux

      In every legislative proposal, Obama’s ask is exactly what he’s hoping to get, apparently on the premise that most negotiations end where they start.

      This, of course, is complete bullshit. His health care and stimulus proposals were both different and better than the final versions passed by Congress.

      Coming out for single payer, a completely empty bluff far outside of the plausible negotiating space, would have provided exactly as much leverage as offering $500 for a new Audi.

      • liberalrob

        I love how you doggedly cling to your assumption of what “the plausible negotiating space” consisted of after the landslide election of a historic figure who enjoyed large majorities of both houses of Congress. And how asking for single-payer or a public option is exactly like offering $500 for a new Audi, not because the situations are remotely analogous but because you want to construct as ridiculous an analogy as possible. Whatever. That horse is dead.

        • I repeat:

          you don’t demonstrate the slightest willingness to learn anything.

          I invite people to read any of your comments in that thread.

          I particularly love that you pretend that Obama didn’t ask for a public option. Or in your slightly more refined claim, that he tossed it out “at the start”. Which I showed just wasn’t true.

          But thanks for confirming my earlier claim that you never learn (at least what you don’t want to learn).

          • liberalrob

            I repeat:

            Whatever.

          • The Temporary Name

            I invite people to read any of your comments in that thread.

            Jeepers, it looks as if liberalrob does not know stuff and does not want to know stuff. It’s a variation of “Opinions can’t be wrong.”

            • Yes and he seems proud of it.

              Of course his actions belie his claims. He continues to attempt to refute people, but somehow feels he gets to declare a draw when refuted.

              Very strange!

              His desperate holding one to factual errors which support his bonkers world view is moderately amusing.

              • liberalrob

                So it’s OK for you to continue to “refute” me because you think I’m wrong, but it’s not OK for me to continue to refute Lemieux because I think he’s wrong. Got it.

                • Wow, again you get so basically wrong.

                  I’m not the one complaining about beating a dead horse (every time it rises up)…you are.

                  So no hypocrisy on this side.

                  Plus, you got your scare quoted refutes in the wrong place.

                  Let’s take a simple one: you claimed Obama gave up on the PO from the start, I cited speeches well into the process of him pushing for it

                  This is a simple factual error. Can you admit it?

                • Scott Lemieux

                  continue to refute Lemieux

                  Assumes things that have not happened.

                • The Temporary Name

                  Opinions=refutations.

                • liberalrob

                  I told you then:

                  Yes, the President made a bunch of speeches. But it doesn’t look like he worked very hard to get Max Baucus under control, or Joe Lieberman. He just let them do their thing, waiting for them to send something to his desk. Well, they did.

                  Great, he gave a bunch of speeches. Awesome! Meanwhile,

                  Behind the scenes, however, Mr. Obama and his advisers have been quite active, sometimes negotiating deals with a degree of cold-eyed political realism potentially at odds with the president’s rhetoric.

                  So how does it add up to a “simple factual error” for me to claim he wasn’t serious or sincere in his supposed backing of the public option, when it was known that while he was out there giving those wonderful speeches about his support for the public option, his people were in the back rooms negotiating it away?

                  I’m not going to bother asking whether you can admit I have a basis for my belief. Clearly you don’t. Nevertheless, I believe I do.

                • liberalrob

                  continue to refute Lemieux

                  Assumes things that have not happened.

                  Sorry. “Continue to disagree with Lemieux.”

                • I missed this!

                  I told you then:

                  Yes, the President made a bunch of speeches. But it doesn’t look like he worked very hard to get Max Baucus under control, or Joe Lieberman. He just let them do their thing, waiting for them to send something to his desk. Well, they did.

                  This still doesn’t add up to your claim even on the most charitable reading. Obama didn’t drop it. (And Lieberman wasn’t even an opponent until it *looked like it was going to happen* when he stabbed it in the back.)

                  So, no. You are plainly wrong.

                  And how does “not working very hard” or even “misjudging how something goes” turn into “Dropped it from the start”? These just aren’t the same thing!

                  Great, he gave a bunch of speeches. Awesome! Meanwhile,

                  Behind the scenes, however, Mr. Obama and his advisers have been quite active, sometimes negotiating deals with a degree of cold-eyed political realism potentially at odds with the president’s rhetoric.

                  How does this help your point?

                  So how does it add up to a “simple factual error” for me to claim he wasn’t serious or sincere in his supposed backing of the public option, when it was known that while he was out there giving those wonderful speeches about his support for the public option, his people were in the back rooms negotiating it away?

                  Even here, “Giving up on it from the start” isn’t the same as “Eventually negotiating it away”. If the choice is ACA without PO or No ACA, I presume we all go with ACA without PO.

                  You reason from the outcome to a deep seated intention. That’s…interesting.

                  I’m not going to bother asking whether you can admit I have a basis for my belief. Clearly you don’t.

                  That’s a form of asking.

                  Nevertheless, I believe I do.

                  Yes, but this belief is entirely unfounded.

                  Consider your discussion of Lieberman. What did you want to do? You wanted to kick him out of the Democratic Caucus to start. So what dies as a result of that? Stimulus? DADT? Health Care Reform? (All almost certainly.)

                  And really, just get up to a Wikipedia level of knowledge here:

                  “Following the Finance Committee vote, negotiations turned to the demands of moderate Democrats to finalize their support, whose votes would be necessary to break the anticipated Republican filibuster. Majority leader Harry Reid focused on satisfying the centrist members of the Democratic caucus until the holdouts narrowed down to Joe Lieberman of Connecticut, an independent who caucused with Democrats, and Ben Nelson, a conservative Democrat, representing Nebraska. Lieberman, despite intense negotiations in search of a compromise by Reid, refused to support a public option; a concession granted only after Lieberman agreed to commit to voting for the bill if the provision were not included,[75][93] although it had majority support in Congress.[94] There was debate among supporters of the bill about the importance of the public option,[95] although the vast majority of supporters concluded it was a minor part of the reform overall,[93] and that congressional Democrats’ fight for it won various concessions, including conditional waivers allowing states to set up state-based public options such as Vermont’s Green Mountain Care.[94][96]

                  This doesn’t sound like abandonment, but fighting to include as much as could be gotten.

                  The election of Scott Brown meant Democrats could no longer break a filibuster in the Senate. In response, White House Chief of Staff Rahm Emanuel argued that Democrats should scale back for a less ambitious bill; House Speaker Nancy Pelosi pushed back, dismissing Emanuel’s scaled-down approach as “Kiddie Care.”[108][109] Obama also remained insistent on comprehensive reform, and the news that Anthem Blue Cross in California intended to raise premium rates for its patients by as much as 39% gave him a new line of argument to reassure nervous Democrats after Scott Brown’s win.[

                  And

                  Unlike rules under regular order, as per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. However, the process is limited to budget changes, which is why the procedure was never able to be used to pass a comprehensive reform bill like the ACA in the first place; such a bill would have inherently non-budgetary regulations.[114][115] Whereas the already passed Senate bill could not have been put through reconciliation, most of House Democrats’ demands were budgetary: “these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they’re exactly the kinds of policies that are well – suited for reconciliation.”

                  You couple your ignorance with your passion and end up with a big ole mess. Over and over again.

              • liberalrob

                …his bonkers world view…

                Woah, wait up. What? Bonkers world view? What is my bonkers world view?

                • I…find it hard to not read you as hugely disingenuous in asking that.

                  AFAICT, from your comments, you believe some mishmash of the following:

                  1) Some version of a public option and most versions of single payer would be better at least for health care in the US.

                  (Most people here would agree. There are possible issues in moving the current system to that which I can’t recall if you poo poo.)

                  2) The ACA would be better if it included one of these.

                  3) It was possible, perhaps easy, to have gotten an ACA with one of these.

                  (There are a bunch of bizarre things mobilised in support of this including

                  3.1 That Obama didn’t do what he in fact did (support the public option)

                  3.2 That there was some sort of leverage that Obama could have mobilised but didn’t by choice because he didn’t want the public option. I.e., Lieberman would have rolled over if [something something].

                  3.3 That a public opinion campaign would have changed the outcome.

                  3.3.1 There was no public opinion campaign in spite of there being one.

                  Etc. etc. etc.)

                  4) Some version of DIDN’T TRY SO WE CAN’T KNOW SO I’M ALLOWED TO BELIEVE IN MY FANTASY OUTCOME.

                  And a bunch more stuff like this.

                  So, for whatever reason, you have a serious commitment to a narrative that you support by, among other things, falsifying facts.

                  Since this gets you pretty much nothing, I think it’s irrational to keep that commitment. Hence, bonkers.

        • Scott Lemieux

          I love how you doggedly cling to your assumption of what “the plausible negotiating space” consisted of after the landslide election of a historic figure who enjoyed large majorities of both houses of Congress.

          The fact that all three major candidates of said party 1)all proposed nearly identical health care plans, and 2)were all to the left of the median vote in the Senate makes it in fact pretty clear what the plausible negotiating space was.

          And how asking for single-payer or a public option

          These things are really not remotely similar, and in addition Obama in fact asked for the latter.

          exactly like offering $500 for a new Audi

          Asking for single-payer would have, in fact, offered exactly as much leverage as offering $500 for a new Audi.

          That horse is dead

          Indeed.

          • Why is it so important to liberalrob that you capitulate, Scott?!??

            Whatever!

            • liberalrob

              It’s not.

              • Sure it isn’t, lil dude!

                • liberalrob

                  I’m 5′ 11″ and 325 lbs. Not so little. Alas…

                • It can be as in “lil John”.

  • maxbsawicky

    Taking Scott’s points in order:

    To all the commenters who have gotten their backs up, remember I say at the outset I mostly agree with PK. OK? It ain’t North Korea, OK? It’s the hippie punching I most object to. I got fewer complaints when I attacked Republicans. Now people say what happened to poor MaxSpeak. Go figure.

    Whether Obama campaigned as a progressive is somewhat in the eye of the beholder. You are either familiar with progressive dog-whistles or you aren’t. I wouldn’t say he campaigned as an ultra-liberal, but I would argue as more than a centrist. For instance, I’m so old I remember he said he would fix Social Security with a higher payroll tax. That isn’t exactly super-liberal, but it is left-er than fixing SS by reducing benefits with the so-called chained price index.

    On ACA (which I see as an advance), yes some complained bitterly and unrealistically about the failure to do single-payer, which I agree was not politically feasible, at least in the short- or medium-term. I would say PK has at least some obligation to tackle the best critical arguments, not the fish-in-a-barrel. One better argument re: ACA was we could have seen a bit more rhetorical love for the public option.

    As for the ACA being “neo-liberal,” that criticism clearly pertains to the exchanges, not to the Medicaid expansion. That doesn’t mean ACA wasn’t worth doing in the end. Those of us in the far-out left worry about bogus exaltation of markets. A neo-liberal reform isn’t necessarily not worth doing, if you can’t get anything better. But it is good to avoid getting into the habit of staking everything on the use of private, for-profit vendors to deliver social services. Everybody here knows why.

    I don’t doubt the public option could not have passed. Nor do I think it would have been world-shaking if it had been enacted. But it could have been talked up more for the sake of public intellectual hygiene.

    This leads to the bully-pulpit issue. I do not think Obama can rule by decree, nor do I blame him for the constraints he faced as far as domestic legislation is concerned. (Foreign policy and law enforcement are another thing entirely, but my post was not mostly about Obama, it was mostly about PK’s reductionism of progressive critiques of Obama.) That aside, Obama could be more educational for the sake of the longer term. For instance, he could have stressed all along that a public option and a bigger stimulus may not have been politically doable, but they would be worth doing. Instead the White House boasts of reducing the deficit when we still have too much unemployment. We need bigger deficits, not smaller ones. This is Macro-Econ 101. They’re making people stupid.

    I did not write about Obama’s dubious negotiating practices. That is salient to Obama’s competence but not especially a matter of progressive critique.

    Bottom line: why talk up stuff you can’t pass right away? If you don’t, it will never ever happen, that’s why. I think the crazy right understands that.

    • BubbaDave

      Bottom line: why talk up stuff you can’t pass right away? If you don’t, it will never ever happen, that’s why. I think the crazy right understands that.

      Yeah, but they do that when they’re out of power. You didn’t hear Dubya complaining that his tax cuts were a failure because they had an expiration date; when Republicans held all three branches they weren’t trying Teahadi-level austerity. Maximalist demands and the like are for when you’re the out party promising ponies for all; once you’re in office every agonizing compromise is sold as an epic achievement.

      • joe from Lowell

        This

        • liberalrob

          And “this” is why people lose faith in the political process, and start looking around for Great Men to actually follow through on delivering what they promise.

          • joe from Lowell

            Do you realize that you’re going back and forth between denouncing the American people as selfish, greedy bastards and proclaiming that they think just like you?

    • simonmd341

      I’d be curious what you think is actually so great about “single payer” Max. Provided, of course, that you know what your talking about when it comes to health reform, which is usually not the case with single payer purists. Single payer has big problems in that it reinforces arbitrary pricing of fee for service medicine and is unable to accommodate increases in productivity and technology easily. But I’m open to counter-arguments that don’t take single payer as a priori holy grail.

      • tsam

        Are you suggesting that an ACA style system is best? Or do you have some other idea for a system that guarantees coverage regardless of the job situation and doesn’t allow crushing debt to ruin families because of an illness? I personally don’t care as long as these and other criteria are met.

        • simonmd341

          I am basically suggesting that. I think in the end the only thing that may be feasible is something like a more heavily regulated Medicare advantage for all, or as it’s known in policy circles, premium support. We could make sure deductibles were not too high or even non existant (my preference) while still assuring that the healthcare delivery model will be able to incorporate advances in technology and process engineering.

          • tsam

            I’ve always thought that open and automatic enrollment to Medicare would bend the system toward a single payer model over time. It would just instantly destroy the health insurance industry, and they could work into a role of local administration and oversight for health care. Sort of a public/private hybrid model.

            • tsam

              It would NOT instantly destroy…

              FYWP–type what I think, not what I type you idiot.

              • Moondog

                It would have been SO easy to explain and to get people behind it: “Medicare for all who want it.”

                Everybody loves Medicare.

                It’s hard to imagine how that could’ve been turned against the Dems the way the ACA was.

                • altofront

                  Joe Lieberman didn’t love Medicare. Remember? And unlike “everybody,” he actually had a vote.

                • tsam

                  I think the opposition to that was the same as the opposition to a public option in that both eventually would lead to a federal system that covers most people. The fear of that is what started the “government takeover” bullshit.

                • joe from Lowell

                  It would have been SO easy to explain and to get people behind it: “Medicare for all who want it.”

                  Everybody loves Medicare.

                  It’s hard to imagine how that could’ve been turned against the Dems the way the ACA was.

                  Do you remember “Keep the government’s hands off my Medicare?” Do you remember “Cutting Medicare to pay for Obamacare?”

                  An older, whiter segment of the population likes a program, so therefore they’re going to automatically support its expansion and the use of taxpayer dollars to provide that service to a younger, poorer, less-white population. Is that your argument?

                  People in the suburbs love the suburbs. Do you see them inviting a whole lot of other people to move in?

                • Moondog

                  My “argument” is that Medicare for all would have been infinitely easier to explain and defend than the ACA.

                • liberalrob

                  People in the suburbs love the suburbs. Do you see them inviting a whole lot of other people to move in?

                  So the reason we can’t have single-payer is that the American people are basically ignorant, selfish bastards. I guess I can’t disagree.

        • Denverite

          This is kind of the point, no? There are a few different ways you can structure a national health care (and health care financing) system. Some are better at some things, some are better at others. (Pre-ACA, the US system wasn’t really good at anything.) But they’re all pretty much OK.

          Obama took us to that point, where we’re arguing subtle points about single provider vs. single payer vs. highly regulated third party payers vs. a hybrid system where the poor and old are single payer and everyone else is paid for by highly regulated third parties. This is really impressive. It’s arguably the biggest liberal achievement in fifty years. Strike that. It’s inarguably the biggest liberal achievement in fifty years.

          • simonmd341

            Exactly. But don’t tell Glenn “in many ways the ACA is worse” Greenwald, Cornel West, Thomas Frank, or apparently Max Sawicky.

          • liberalrob

            Pre-ACA, the US system wasn’t really good at anything.

            Incorrect. The pre-ACA system delivered excellent health care, the best in the world, to those with the money to pay for it. What it was terrible at was delivering that care to those who didn’t have the money to pay for $10,000 MRIs.

            It’s inarguably the biggest liberal achievement in fifty years.

            Not a high bar, with most of those 50 years covered by conservative government…

            • joe from Lowell

              See, you can’t make both of these arguments at once.

              You can’t complain that politics in the United States have been conservative for decades, and then minimize the passage of a huge liberal program on the grounds that it’s not left enough for you.

              If you’re right about the first part, then getting a big liberal program though – even one that doesn’t give you starbursts! – is an impressive accomplishment.

      • maxbsawicky

        Others can judge whether I know what I’m talking about. I prefer single-payer because it cuts away a huge amount of administrative cost and by ensuring everyone, can reduce health care costs overall. Continuous coverage encourages people to have problems treated before they become more expensive. By using market power — setting prices — it can reduce rents captured by medical providers. I don’t buy the productivity/technology argument. A S-P system can also steer resources to treatments that are more effective and away from those that are less.

        I wouldn’t say S-P is utterly essential. Some European countries do well enough with other systems. But nobody is emulating the U.S. system.

        • simonmd341

          I think the continuous coverage argument is probably the strongest. But I don’t see Canada doing anything terribly original on prevention of chronic illnesses. I think the reason is that in a single payer system with a payer/provider split each episode of care is revenue generating for the provider. In some sort of capitated system run by integrated providers (think Kaiser) you do have an incentive to re engineer the care process. This is actually one of the strengths of the NHS, which is not really single payer. But to think that the US populace would settle for something like THAT, where you can’t even pick your own specialist, is nutty (not saying you beleive this).

          You’re right that nobody is emulating the ACA, but the ACA is emulating Germany, Netherlands, and Switzerland for example.

          • liberalrob

            …to think that the US populace would settle for something like THAT, where you can’t even pick your own specialist, is nutty.

            Who really does this? Who actually goes out and picks their own specialist? I have no fking clue who I’d pick for a specialist for something; I’d rely on my family doctor to recommend one, and I’d probably take their recommendation without a second thought (or a second opinion) because I have no idea who is better or worse. Yet somehow this right to pick your own specialist or your own doctor is this hugely important thing you supposedly have to give up in order to have single-payer. This thing that practically nobody does! My god we’re stupid.

    • joe from Lowell

      It’s the hippie punching I most object to.

      Why is it always the people who devote the most time to ripping Democrats who turn around and scream “No fair!” when a Democrat criticizes them?

      Anyway, a big House majority and the reduction of the Republicans to 40 seats in the Senate is not the time to sacrifice a single iota of substantive accomplishment for the sake of “public intellectual hygiene.” It’s the time to collect up all of your ski-ball tickets and buy yourself the very biggest stuffed animal you can afford with the winnings you’ve got.

      • maxbsawicky

        Criticism is fine. Unfounded criticism is . . . unfounded.

        I like the ski-ball remark. I think we have enough stuffed animals. Just look at the U.S. Senate.

        • joe from Lowell

          Criticism is fine. Unfounded criticism is . . . unfounded.

          The term “hippie-punching” is a rhetorical trick to define all criticism of “hippies” as out of bounds. If an argument is wrong, tell me that it’s wrong. An argument does not become unfounded because it is directed to the speaker’s left.

          In case the metaphor wasn’t clear, the ACA is the stuffed animal. It’s the prize we got for winning three consecutive elections.

          • maxbsawicky

            Well I tried to do that in my post. Which you ignored. Cheers.

            • joe from Lowell

              Actually, I was objecting to your comment. Hence, a reply to the comment.

            • joe from Lowell

              Well I tried to do that in my post.

              The key word being “try:”

              This is some tired anti-progressive treacle…I interpret this as the fatal, common affliction of all bigfoot pundits. You have to throw some obligatory brick at the left to guard against the suspicion that you are too far Out There. Actually, the fact that PK puts neo-liberalism in quotes proves that well enough.

              You “interpret” any criticism of yourself and people like you as hippie-punching this way because it’s a universal law that it’s gotta be. Nobody actually has an argument why you’re wrong, and is advancing that argument because they believe different things than you. No, Paul Krugman just desperately needs the…um, what’s this guy’s name again?…of the world to secure his position, because without some unprincipled “hippie-punching” who would possibly pay him any attention?

              OR MAYBE HE ACTUALLY THINKS YOU’RE WRONG!

          • liberalrob

            In case the metaphor wasn’t clear, the ACA is the stuffed animal. It’s the prize we got for winning three consecutive elections.

            I like it. The prize we got for winning three consecutive elections is a cheap Chinese stuffed Chihuahua. Perfect!

            • joe from Lowell

              There are tens of millions of people able to see the doctor now who couldn’t before.

              Sorry that doesn’t give you starbursts. Maybe if there was a giant puppet involved….

              • Scott Lemieux

                The public option would have been Uncle Sam on stilts!

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  • Moondog

    First of all, a public option was worth trying, but I don’t agree that it was a magic bullet that would have transformed the ACA from hopeless neoliberalism to real progressivism. The public option passed by the House would have had, at best, a minor impact on the exchanges.

    Well, “the public option passed by the House” is NOT the public option that might have transformed the ACA.

    That such a weak option came out of the House … at the time, at least, I thought that was due to a failure of leadership by the President on this signature legislation.

    It was not the road to nationalizing the health care industry.

    Who made that claim? I thought the main argument was basically, a good public option will keep the industry plans honest and affordable. And the insurance companies screamed “unfair,” which I think means they agreed.

  • simonmd341

    IMO lefties who derp “single payer” the most are the ones who have thought the least about health care reform, markets, and innovation. The fact is that many if not most other countries with universal health insurance don’t have a single payer. Germany has thousands of private payers. What they all do is bargain for prices with providers, and even this is not without it’s downsides (it locks in fee for service medicine, for instance.) This Ezra Klein piece is helpful. http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/

  • What I know is, before the ACA took effect, I couldn’t get individual health insurance from any provider, at all. I now have Medi-Cal, which isn’t perfect, but is a hell of a lot better than nothing. To people who think that the ACA was worse than nothing, you can go fuck yourselves with a chainsaw, sideways.

    • Steve LaBonne

      This. My 21 year old daughter is able to stay on my excellent employer-provided plan because of ACA. My wife’s 27 year old son with a spotty employment history is able to buy affordable insurance that actually has worthwhile coverage because of ACA, instead of the useless ripoff “catastrophic” plan he had before. Try to tell me ACA is no big deal and I will repeat Nostradumbass’s invitation.

    • tsam

      This.
      This illustrates the entire premise of liberalism. It’s easy to get all bent sideways over the ACA not being a carbon copy of Canada’s system when you have health insurance through your employer and haven’t lost a job or had to deal with a catastrophic illness. Essentially the difference between conservatives and liberals (these days) is that liberals are supposed to care about the less fortunate and work toward helping them out instead of making excuses for letting people suffer without health care, education, food, shelter and Obamaphones.

    • liberalrob

      To people who think that the ACA was worse than nothing, you can…

      Good thing I don’t believe that, then.

  • mch

    I give Obama more than a pass on health care. Even on macro, where he got timid but did something. But not on the nitty-gritty of finance. Things like mortgages. That’s where where he crapped out totally. And where Krugman needs to talk seriously with Warren (not some 42nd St Y event, just).

  • joe from Lowell

    What the not-actually-stupid left really wanted and had a right to expect was the inclusion of some kind of public option, which was arguably not a manifestly disabling feature from a political standpoint. And even if it proved to be so,

    “Even if?” They argued over the public option for months. They lost. We don’t have to guess here: it turn rout to be a manifestly disabling feature from a political standpoint. It proved to be so, and they had to drop it to get the bill past.

    This isn’t speculation anymore.

    • liberalrob

      They lost, but only narrowly. It wasn’t a non-starter. And the way they lost, and the people that caused that loss, really sticks in the craw.

      • Given your track record of blatant, repeated-after-documented-refutation-about-simple-facts error, I would strongly recommend at least looking things up first and providing some citation.

        You’re just wrong here and were shown wrong *on this point* before.

        • liberalrob

          No, you argued that I was shown wrong. I disagreed. The world continued to spin on its axis.

          I don’t understand why you continue to reject my declarations of impasse on this. Why is it so important to you that I capitulate?

          • I don’t care at all that you capitulate. I merely will continue to refute the false factual claims you persist in making.

            (I’ll also continue to point out other problems with your arguments. But the factual ones are a real tell.)

            At this point, you are simply lying about various events. I don’t know why you think this is a good move.

            (Note that this factual errors are distinct from your counter factual and strategic howlers about the leverage available at the time and vacuous claims that failure always indicates a specific will based failure. But they are, in a sense, of a piece. You have a line and by gum you will stick to it without regard for any fact or sense.

            Again, I fail to see why you think this is good.)

            • liberalrob

              I am not lying, I am saying what I believe. I have no reason to lie about anything. As far as “factual errors,” I don’t believe I’ve made any. Whatever the evidence behind your claim is, I don’t find it convincing. So refute away, I still think you’re wrong to make that accusation.

              • Hogan

                Whatever the evidence behind your claim is, I don’t find it convincing.

                Before you’ve even seen it? Wow. I am awesomed by you.

              • I am not lying,

                We can quibble on the precise term, but I think at this point, your falsehood spouting is so negligent that it’s functionally lying.

                I am saying what I believe.

                If you willfully deny facts which are evident to you, I think you are lying. You might start by lying to yourself, but so?

                I have no reason to lie about anything.

                Clearly you have plenty: E.g., the world doesn’t conform to your fantasy.

                As far as “factual errors,” I don’t believe I’ve made any.

                Since your evidential standard is “If it supports my narrative it’s good; if not, it isn’t” I’m not surprised.

                Whatever the evidence behind your claim is, I don’t find it convincing.

                Hah hah ha ha. This seemed like a *good* thing to write?

                So refute away, I still think you’re wrong to make that accusation.

                You think a lot of things and most of them are wrong as well as self-serving.

                At this point, I kinda feel sorry for you. If this is trolling, it’s pretty weak stuff. And that’s the best case scenario for you.

      • joe from Lowell

        They lost, but only narrowly. It wasn’t a non-starter.

        No, it wasn’t a non-starter; that’s why the Obama administration started it. Are you sure you aren’t confusing the public option (never called a non-starter) with single payer (a non-starter?)

        And the way they lost, and the people that caused that loss, really sticks in the craw.

        Joe Lieberman and Max Baucus piss me off, too, but what is that supposed to do with the Obama administration?

        I would take all of this rhetoric about the Obama administration being a disappointment for not fighting the good fight a lot more seriously if the people expressing it were ever willing to show them any respect for the times the fought the good fight and lost, at a political cost to themselves.

        Instead, whether we’re talking about closing Gitmo, the public option, civilian trial for KSM, or card check, all they do in those situations is blame them.

        • No, it wasn’t a non-starter; that’s why the Obama administration started it. Are you sure you aren’t confusing the public option (never called a non-starter) with single payer (a non-starter?)

          Apparently, in liberalrob’s world, making speeches and negotiating doesn’t count as doing anything, thus Obama dropped the PO “fron the start”.

          Joe Lieberman and Max Baucus piss me off, too, but what is that supposed to do with the Obama administration?

          That Obama didn’t “manage them” (i.e., succeed) shows that they didn’t want to. If they really wanted to, they would have “done what it takes”, e.g., kick Lieberman out of the caucus.

          I would take all of this rhetoric about the Obama administration being a disappointment for not fighting the good fight a lot more seriously if the people expressing it were ever willing to show them any respect for the times the fought the good fight and lost, at a political cost to themselves.

          But failure is just evidence that they didn’t fight the good fight but sold out. Any (compromised) win means you could have won more thus you sold out.

          Bonkers, as I said above.

  • joe from Lowell

    You know, Scott, there’s another angle from which the “neoliberal” claim is stupid, beyond the Medicaid expansion: the huge expansion of the federal regulatory state’s oversight of private health insurance.

    Is the contraception mandate neoliberal? The profit/overhead caps? Those things work through private health insurers!

    The word “neoliberal” has lost a lot of its meaning, but surely it doesn’t yet cover the expansion of regulation of large corporations in the public interest.

    • altofront

      Yeah, there’s nothing “neoliberal” about telling insurance companies, “you must spend 80% of your revenue on paying for healthcare or we’ll force you to give refunds.”

    • Scott Lemieux

      That’s what I was getting at in the last paragraph. I don’t understand how something that substantially increases regulation is “neoliberal.” It only makes sense if the implicit baseline is the NHS rather than the actually existing status quo ante.

    • maxbsawicky

      Repeating my point that ‘neo-liberal’ is not necessarily an adverse move, in historical context, I still say the use of private sector, for-profit vendors to provide social services is, in general, not preferable to public means. I supported passage of ACA and still think it is an advance, but I would hate for it to be the eternal model for progress in the U.S. welfare state.

      • joe from Lowell

        the use of private sector, for-profit vendors to provide social services is, in general, not preferable to public means.

        But that wasn’t the question.

        The question was whether taking a market full of for-profit players and subjecting them to a great deal of regulation, which subsidizing poor people to purchase their product, is “neoliberal.”

        Nothing related to the ACA involves choosing private vendors over public means.

        • Ronan

          Neo liberal is a slippery and vague term that’s lost most of its analytic usefulness (imo)..but if you look at neo liberalism (as Colin Crouch does in his book ‘The Strange non death of neo liberalism’) as:

          ” effectively “devoted to the dominance of public life by the giant corporation.” What neo-liberals, and some leftists, see as a conflict between the market and the state is in fact an argument over how the two should relate to each other. Neoliberals are not pushing for free markets so much as a certain style of politics, which masquerades as a commitment to free markets, independent of politics, but in fact is an unhealthy hybridization of the two. To the extent that politics pervades markets, and markets pervades politics, both suffer.” (that’s henry farrell review at crooked timber, Ive read the book but couldnt put it as succintly)

          Then it makes some sense to call it neo liberal ( i think)

  • mere mortal

    which was arguably not a manifestly disabling feature from a political standpoint

    Someone put those words together on purpose.

    I submit that anyone who would put those words together on purpose is a weasel.

    • maxbsawicky

      Weasels often post anonymously, I’ve noticed over the years.

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